3个with怎么理解？是不是这里省略了一个with？

Ankylosing spondylitis, primarily responsible for sacroiliitis evident in this patient, is a multifactorial disease with an interaction of the genetic component with gut microbes and immune modulation with IL-17 as a critical mediator. Understanding the pathogenesis of the disease also simplifes the treatment options. The treatment options can be divided into nonpharmacological and pharmacological treatments. Non-pharmacological treatments include physical therapy, such as scheduled and supervised physical therapy that was particularly shown to be superior to non-supervised physical training. A recently published Cochrane review was intended to demonstrate an exercise regime for the lower back pain resulting from ankylosing spondylitis. However, the authors were unable to formulate a specifc exercise plan that would help the people with lower back pain.Pharmacological treatments include frst-line 31 A 33-Year-Old Patient with Persistent Back Pain drugs such as NSAIDs; however, TNF-alpha inhibitors and glucocorticoids have a distinct role in suppressing the infammation

该例患者中，主要造成骶髂关节炎的强直性脊柱炎是一种多因素疾病，包括遗传成分与肠道微生物和以IL-17为关键介质的免疫调节的相互作用。了解疾病的发病机制可简化治疗方案，治疗方案可分为非药物治疗和药物治疗。非药物治疗包括物理治疗，相比无监督的物理训练，已证明如计划和监督下的物理治疗更优。针对强直性脊柱炎引起的腰痛，最近发表的一篇Cochrane综述旨在展示一种锻炼方案。然而，作者无法制定一项具体的帮助腰痛运动计划。药理学治疗时，非甾体抗炎药是一线药物，然而肿瘤坏死因子-α抑制剂和糖皮质激素在抑制炎症方面也作用独特。

disease with，with伴随状语

interaction----with----

immune modulation with IL-17 as a critical mediator，with补充状语？

interaction----（with）immune modulation？是不是这里省略了一个with，否则句子结构难以理解？